The NHS should stop operating on minor varicose veins and scrap a range of
other 'urban myths' and traditions that waste money, a report has said.

Dozens of practical measures to save money, cut waste and improve efficiency have been suggested by doctors, surgeons and consultants in a report published by the NHS Confederation, a charity which represents health service organisations.

Under seven chapter headings, doctors in different specialities have outlined where savings can be mad, including throwing away fewer surgical instruments, cutting referrals to consultants and discharging premature babies earlier.

The NHS is struggling to make £20bn of savings over the next four years as extra funding from the government dries up while demand and costs continue to rise.

The Health Select Committee said in a report this week that the 'unprecedented' scale of the savings will 'test the NHS to the limit' and such a task has never been attempted anywhere in the world.

The report, Clinical Responses to the Downturn, highlighted the number of unnecessary procedures carried out across the NHS, the waste of expensive surgical equipment and the need for improvements to the way referrals from GPs are managed.

Doctors use different thresholds for when to refer patients to specialists, operating theatres could be used until 7pm instead of 4pm and efficiencies can be made when discharging patients home, the report said.

Pre-admission clinics should be set up to check patients were fit for surgery to avoid admitting them only for their operation to be delayed and separating emergency surgery from elective operations would mean fewer operations and clinics were cancelled.

The amount of savings possible with the changes suggested in the report has not been calculated but is thought it could run into hundreds of millions without having an adverse impact on patients.

There are widespread fears that the scale of the savings will mean managers simply cut services with evidence already emerging as primary care trusts ban fertility treatment on the NHS and ration operations.

Hugo Mascie-Taylor the NHS Confederation's clinical director said: "The NHS is facing up to the need to save as much as £20 billion in the next four years so suggestions like these from some of the most respected clinicians in their field simply have to be taken seriously.

"There are huge challenges facing the health service but what is heartening about this report is that there are ways both to save money and improve the care we provide to people.

"This is the start of an important debate and these ideas need to be considered carefully. The NHS treats millions of people a year and does so with care and professionalism but there are always ways to improve, to do things better and to reduce waste at the same time."

The foreword to the report said: “The premise of this report is that when change needs to happen rapidly, in evidence-based and highly sensitive fields, it is best to ask the experts.

“Numerous initiatives are under way to try to identify where money can be saved, yet feedback we received suggested that very few of them were engaging doctors in any meaningful way.

“It is clinicians who commit most of the NHS’ resources and feel responsible for the care given to individual patients.”

Health Secretary Andrew Lansley said: “We believe in the NHS and are committed to delivering continuous improvements in services. Every penny saved from efficiency savings will be reinvested back into patient care. That includes a 45% cut to bureaucracy.

"It is far more effective if health professionals are engaged in this. I welcome the important work they are doing to meet efficiency savings whilst ensuring high quality patient care."

The report found:

Outdated myths about only discharging babies when they reach a certain weight or age still perpetuate and mean healthy babies are needlessly kept in special care, the report said.

In some areas over a third of babies are admitted to special care after uncomplicated births due to outmoded clinical practice and if more breastfeeding were encouraged in special care, it would save costs in tube feeding.

The report added that infection control was 'still substandard in many units' meaning babies were put at risk and needed longer stays in hospital, costing more.

It also warned that greater education was needed of the risks of multiple pregnancies following IVF which means more babies require special care. It is feared that cuts to NHS funding of IVF will drive more patients abroad where treatment is more likely to result in twins or triplets, the report said.

Orthopaedic surgeons have called for a quicker turnaround for patients needing surgery to reduce the number of operations done in the evenings and weekends as the patient is about to breach waiting times, would be cheaper.

Red tape means surgeons cannot refer a patient to another consultant even when the GP has picked the wrong doctor for the procedure resulting in unnecessary delays as the patient is sent back to their family doctor, the report said.

Over-use of MRI scans by junior staff and physiotherapists who cannot interpret the results generate needless referrals to consultants and surgeons should meet with their local GPs to agree guidelines about who to refer and when.

The European Working Time Directive, which has cut junior doctors' hours, has pushed up agency costs, the report said.

Vascular surgeons have said the NHS carries out too many operations on minor varicose veins and new guidance should be drawn up by the National Institute for Health and Clinical Excellence on the matter.

Money could be saved by concentrating highly complex and high risk surgery into fewer specialist units with all hospitals still providing the more routine treatments.

Admitting patients on the day of surgery instead of earlier and using operating theatres later into the evening would also save money, the report said.

Meanwhile the British Geriatrics Society said having an old-age specialist in A&E to care for elderly patients should speed up their treatment. Recording the preferences of the patient on end of life care, resuscitation and admission to hospital would also save unnecessary and invasive treatments.

Hospitals should provide round-the-clock specialist care instead of focusing on a nine to five day, the report said,

Doctors are ordering too many tests and using them as a 'medical crutch' because they lack training in what is appropriate and necessary, pathologists said in the report.

'Tick box' style forms to request tests encourage doctors to ask for more tests than are necessary and these should be changed to make doctors write out each lab test they would like conducted.

Pathologists should question inappropriate tests more often and the NHS should use the latest lab tests that are available as in many cases these can avoid the need for more expensive scans and biopsies, the report said,

Duplicate tests are common and in one in ten cases, test results are not even looked at, the report said.

Brain surgeons warned that the mad cow disease scare has led to vast numbers of expensive surgical instruments being thrown away after only one use.

They said the waste was not necessary as the risk from vCJD was extremely small, however guidelines say that any equipment used on someone who has been classed as 'at risk' of vCJD because they may have received blood products from someone who went on to develop the disease, should be thrown away afterwards.

The British Society of Neurological Surgeons said the guidelines: "They are founded on estimated, notional risks that since implementation have subsequently been revised down. Yet there has been no change in the policy.”

Skin specialists also highlighted unnecessary treatments and minor operations which the NHS continues to provide, such ass removal of skin tags and suspect lesions.

Consultants should check lesions before they are automatically removed as surgery can be avoided in a large proportion of cases, the report said.

Text and email reminders of appointments should be sent to patients as they have been shown to to reduce the number of patients not turning up.

Many follow-up appointments can be done over the phone and for those with long-term conditions these could be done by nurses, the report said.

Expensive branded drugs should be swapped for cheaper generic versions and common conditions can be managed by GPs, the report said.